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Barcode 128
IN’4 APPLICATION FOR VARIANCE
FROM
OTTER TAIL COUNTY, MINNESOTA
706S87 969^9
A6-00
Receipt No.
Application Fee $
Phone: “Owner:
Last Name 'MiddleFirst
22Z.
Street & No.City State Zip No.
(S' DLake No.Lake Name Lake Class
(jl'rnMJAiSec.Twp.Twp. NameRange
Legal Description:Fire No.
Parcel Number
Explain your request:
In order to properly evaluate the situation, please provide as much supplementary information as possible, such as: maps, plans, information about surrounding property, etc. APPLICIANT SHALL BE PRESENT AT THE SCHEDULED HEARInG.
I understand that I have applied for a variance from the requirements of the Shoreland Management Ordinance of Otter Taii County.
I understand I must contact my township in order to determine whether or not any additional variances and/or permits are required
by the township for my proposed project.
/^ - A -19 . XApplication dated.
Signature of Applicant
— DO NOT USE SPACE BELOW—
! Mt :,1Q_Date of hearing Time M.
Court House, Fergus Falls, MN. 56537
; /DEVIATION APPROVED this______
(OR A TTACHED) REOU!REMENTS:
19_____WITH THE FOLLOWINGday oL
Oiiice of County Recorder
County of Otter Taii
I liefeby certify th*i it» wtiwi wtr»-
rrrfinl was
Ve.nyLe.d... .no adequate haAd&hJjp shorn.1111190
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Signature:
Chairman
Otter Tail Board of AdjustmentMKL 0483 -001
■'’■•.616 — Victor Lundeen Co., Printers, Fergus Fails, Minnesota
V t 1Scale': Each'grid equals feet/inches GRID PLOT PLAN SKETCHING FORM: : I i
V.
Dated:
Signature
Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently
on lot and any proposed structures.
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